Environmental emergencies

Question 1

If too hot, body will

Answer 1

vasodilate 
Increase perspiration
Decrease heat production
Increase cardiac output
Increase resp rate

Question 2

If too cold, body will

Answer 2

Vasoconstrict
Decrease perspiration
Increase heat production
Decrease cardiac output
Decrease resp rate

Question 3

Mild hypothermia

Answer 3

89.6 - 95 F
Shivering
Tachypnea, tachycardia, HTN
Ataxia, dysarthria
Loss of fine motor coordination
Confusion, lethargy

Question 4

Moderate hypothermia

Answer 4

82.4-89.6 F
Shivering stops
Bradycardia
J waves on ECG
Altered mental status
Slowed reflexes
Cold diuresis 
Pupillary dilation

Question 5

Severe hypothermia

Answer 5

< 82.4 F
Unresponsive, coma
Hypotension
v-fib/asystole 
Acidemia 
Loss of reflexes

Question 6

Describe the two types of frostbite

Answer 6

Superficial and Deep

Question 7

Heat emergencies

Answer 7

Heat edema
Heat rash
Heat syncope
Heat cramp
Heat exhaustion
Heat stroke

Question 8

Sequence of drowning

Answer 8

Sequence
Submersion → breath holding → panic → swallowing water and emesis → breathing in water → exhaustion → cardiopulmonary arrest
End result = hypoxemia

Question 9

Drowning

Answer 9

Death within 24 hours of submersion

Question 10

Heat edema

Answer 10

Cutaneous vasodilation and orthostatic pooling

Resolved spontaneously if treatment started → remove from heat, elevate legs

Question 11

Heat rash

Answer 11

Pruritic maculopapular rash

Treatment: avoid heat exposure; wear light loose fitting clothes, minimize sweating

Question 12

Heat syncope

Answer 12

Due to peripheral vasodilation, decreased vasomotor tone, and/or volume loss
Treatment: remove from heat, oral fluids and rest

Question 13

Heat cramp

Answer 13

Usuaully due to electrolyte imbalance from sweating

Treatment: remove from heat, oral hydration with electrolyte containing fluids

Question 14

Heat exhaustion

Answer 14

s/sx
fatigue/weakness/dizziness/syncope
n/v
Headaches
Muscle cramps
Tachycardia
Piloerection
Profuse sweating
Treatment: remove from heat and minimize activity, cool with fans, ice pack to neck/groin/axillae, oral hydration w/ electrolyte containing fluids, monitor VS

Question 15

Heat stroke

Answer 15

s/sx
Tachycardia, tachypnea, increased SBP and Pulse pressure
CNS dysfunction: seizure, delirium, cerebellar dysfunction, coma, hallucinations
Oliguria (decrease urine output)
Anhydrosis (not always)
Absence of sweating

Question 16

Descent barotrauma

Answer 16

Ear squeeze
Sinus squeeze
Mask squeeze
gas pockets are compressed

Question 17

Ascent barotrauma

Answer 17

Essentially reverse of squeeze
Instead of gas being compressed, it expands w/o anyway to escape
Tooth squeeze when descending, air expanding when ascending → PAIN!
Air trapped in GI tract
Pulmonary barotrauma
Pneumomediastinum and subcutaneous air common but usually self-limiting
Possible pneumothorax and arterial gas embolism

Question 18

Nitrogen narcosis

Answer 18

Increased solubility at increased partial pressure
Essentially, the deeper you go, more nitrogen is dissolved in your blood → causes intoxication effect akin to alcohol
Effects reversed when you ascend

Question 19

Decompression sickness

Answer 19

Nitrogen bubble formation as a result of rapid ascension
Results in decreased tissue perfusion, ischemic injury
Type I
“Niggles” - mild pain
“Skin bends” = pruritis (itchy skin)
Skin rash
Peripheral edema
“The bends” - aching pain usually in joints/muscles
Type II
Nervous system
Spinal cord most commonly affected
Bladder dysfunction
Pulmonary decompression sickness
Nitrogen emboli in the venous system
s/sx: CP, cough, dyspnea, pulmonary edema, hemoptysis

Question 20

Treatment of decompression sickness

Answer 20

Remove from water, immoblize if trauma
Supp O2
CPR if indicated
Avoid trendenlenburg

Question 21

Contribuatory factors cold emergencies

Answer 21

Inappropriate clothing 
Being wet/immersed
Prolonged exposure
Very old/very young
EtOH/drugs/poison

Question 22

“Hunting Response of Lewis”

Answer 22

Alternating cycles of vasodilation and vasoconstriction at < 100 C (500 F)

Question 23

Deep frostbite

Answer 23

3rd degree: hemorrhagic blisters w/ eschar

4th degree: necrosis (involves muscle/tendon/bone)

Question 24

Superficial frostbite

Answer 24

1st degree: non-sensate white area with surrounding erythema

2nd degree: vesicles with surrounding erythema

Question 25

Erythema

Answer 25

superficial reddening of the skin, usually in patches, as a result of injury or irritation causing dilatation of the blood capillaries.

Question 26

Treatment for frosbite

Answer 26

Remove the patient
from further exposure
to the cold.
 Handle the injured
part gently.
Administer oxygen.
Remove any wet or
restrictive clothing.
Never rub the area.
Do not break blisters.
Transport.

Question 27

Temperature regulation is controlled by the ____

Answer 27

Hypothalmus

Question 28

Impaired heat dispersion may be due to:

Answer 28

Cardiovascular disease-impaired circulation and compensation
Obesity
Clothing
Skin alterations
Medications-anticholinergics, cardiovascular drugs,diuretics, sympathomemitics, phenothiazines, alchohal/drugs
Extremes of age
Dehydration

Question 29

For hyperthermia, what type of cooling is preferred?

Answer 29

Evaporative cooling